Provider Demographics
NPI:1508071903
Name:T CLARBOUR MD LLC
Entity Type:Organization
Organization Name:T CLARBOUR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-955-8033
Mailing Address - Street 1:1033 RANDOLPH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3453
Mailing Address - Country:US
Mailing Address - Phone:708-955-8033
Mailing Address - Fax:708-445-8444
Practice Address - Street 1:1033 RANDOLPH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3453
Practice Address - Country:US
Practice Address - Phone:708-955-8033
Practice Address - Fax:708-445-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Not Answered207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty